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Writing off a write-off

In his last months as NHS Improvement chief executive, Ian Dalton said government would “have to have a serious look” at writing off some of the debts incurred by providers, as it was “deeply unlikely” they could be repaid.

Trusts’ combined debts to the Department of Health and Social Care reached £14bn by the end of 2018-19, with more than half of that relating to around 30 providers.

The debt has risen steeply over the last three years, as dozens of trusts with budget deficits have become reliant on interest-bearing loans to maintain payments to staff and suppliers. The debts have now far surpassed trusts’ combined private finance initiative liabilities, which stand at £9bn.

Although the interest rates on the loans vary, total interest payments were £292m last year, which is an average rate of around 2 per cent. King’s College Hospital Foundation Trust paid a whopping £17m of interest charges (almost 3 per cent).

The prospects of a write-off don’t sound all that favourable though, with the most indebted trusts telling HSJ this does not appear to be on the table.

Most will hope to persuade the DHSC to take a haircut, or try and negotiate additional income to ensure they can make the repayments.

NHS England’s Improving Access to Psychological Therapies scheme has opened access to counselling services for many people. With more than a million people referred each year, it is the key non-medicinal route for people with low to moderate mental health conditions, such as depression. 

Such demand for one-to-one interventions has meant IAPT has had to expand its workforce, with many areas turning to private providers to top up care from mental health trusts. 

In Kent, those private providers – who are often quite small organisations – have been particularly prominent. But the decision by NHSE last year to require all practitioners to have completed an accredited course for the particular therapy they deliver has caused disruption.

A workforce review in Kent is believed to have shown many IAPT counsellors did not yet have the required qualifications. At one point, NHSE recommended restrictions on what work they should be allowed to carry out, which could have affected the ability of services to see those referred.

A compromise has since been reached, which allows providers extra time to make sure staff have the correct accreditation and should reduce the risk of patients not being able to see counsellors.

But the region’s clinical commissioning groups are still concerned. Dartford, Gravesham and Swanley CCG warns there is still a chance counsellors could refuse to take on NHS work “before or during” the accreditation process. Meanwhile, one provider reports counsellors have left because of the accreditation issue.

The problem may be more acute in Kent but it is unlikely that the county is alone in facing this difficulty. The last published national review of the IAPT workforce dates back to 2015. When NHS Digital starts to publish more IAPT workforce data next year, the extent of the problem may become clearer.